Redesigning the Regulatory Framework for Ambulatory Care Services in New York

December 2014 | Dave A. Chokshi, John Rugge, Nirav R. Shah | Review Article

Policy Points:

  • The landscape of ambulatory care services in the United States is rapidly changing on account of payment reform, primary care transformation, and the rise of convenient care options such as retail clinics.
  • New York State has undertaken a redesign of regulatory policy for ambulatory care rooted in the Triple Aim (better health, higher quality care, lower costs)—with a particular emphasis on continuity of care for patients.
  • Key tenets of the regulatory approach include defining and tracking the taxonomy of ambulatory care services as well as ensuring that convenient care options do not erode continuity of care for patients.

Context: While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public’s interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state’s ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves.

Methods: We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review.

Findings: The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory care services. From the state government’s perspective, this clarification requires better reporting from new health care entities (eg, retail clinics), connections with regional and state health information technology hubs, and coordination among state agencies. A uniform nomenclature also would improve consumers’ understanding of rights and responsibilities. Finally, the regulatory mechanisms employed—from mandatory reporting to licensure to regional planning to the certificate of need—should remain flexible and match the degree of consensus regarding the appropriate regulatory path.

Conclusions: Few other states have embarked on a wide-ranging assessment of their regulation of ambulatory care services. By moving toward adopting the regulatory approach described here, New York aims to balance sound oversight with pluralism and innovation in health care delivery.

Author(s): Dave A. Chokshi, John Rugge, and Nirav R. Shah

Keywords: health policy, ambulatory care, primary care, regulation

Read on Wiley Online Library

Volume 92, Issue 4 (pages 776–795)
DOI: 10.1111/1468-0009.12092
Published in 2014